Is it time to discard the Diagnostic and Statistical Manual of Mental Disorders (DSM) in psycho-oncology?

The conceptual basis of psychopathology within cancer survivorship is critical, as the chosen conceptualisation informs assessment and explanatory models, as well as interventions and supportive care approaches. The validity of a chosen conceptualisation of psychopathology is therefore paramount for ensuring cancer survivors receive high-quality and efficacious care and support that can be iteratively improved via coordinated research efforts. In this paper, we discuss the traditional diagnostic approach to conceptualising psychopathology within cancer care, including the diagnostic system the 'Diagnostic and Statistical Manual of Mental Disorders' (DSM) [1], and the significant issues it presents within cancer survivorship. We detail and discuss how an alternate conceptualisation of psychopathology may enhance both research and practice within psycho-oncology. We ultimately pose, and provide our perspective, on the question "Is it Time to Discard the DSM in Psycho-Oncology?"

Stress as a mediator of brain alterations in attention-deficit hyperactivity disorder: A systematic review.

OBJECTIVE: Stress is a known risk factor for numerous psychopathologies, whereas evidence is lacking regarding the specific consequences of stress on the neural basis of attention-deficit hyperactivity disorder (ADHD). A systematic literature review was thus conducted to clarify the role of stress in the association between the resulting alterations of brain structure, connectivity, and function in ADHD. METHODS: The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under identifier CRD42023379809. A systematic search of the PubMed and CINAHL databases was conducted for articles published prior to December 22nd, 2022. Retrieved literature was screened in Rayyan and data extraction was performed with respect to neuroimaging, stress exposure, and ADHD outcomes. The Quality in Prognosis Studies (QUIPS) tool was adapted based on the Conducting Systematic Reviews and Meta-Analyses of Observational Studies of Etiology (COSMOS-E) guidance article to assess risk of bias and quality of studies. Strength of the evidence was assessed under the guidance of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS: Screening 25,026 non-duplicate articles yielded 20 eligible studies for inclusion. Exposure to early life trauma, institutionalization, prenatal smoking or alcohol consumption, air pollution, low socioeconomic status, or low birth weight were associated with alterations in brain structure, function, and connectivity in ADHD. However, most studies did not provide strong evidence due to small sample sizes and lack of statistical approaches to determine a direct mediation of the association between stress and ADHD by neural outcomes. CONCLUSION: This systematic review was the first to summarize evidence of structural and functional stress-associated alterations in the brain, which were found to be directly and indirectly associated with ADHD outcomes. Overall, stress requires consideration as a significant determinant of neurodevelopmental outcomes in ADHD. However, extensive further research is warranted due to little available evidence and the difficulty of obtaining clear results. In light of such a complex research question, in order to confirm findings, provide further evidence, and establish causality systematic longitudinal studies would be required. Investigating the topic may provide invaluable information when it comes to tailoring prevention and treatment strategies in ADHD, and should be pursued in order to integrate the factor of stress into a more comprehensive understanding of ADHD.

Pre- and Perinatal Risk Factors for Youth with Autism Spectrum Disorder Versus Youth with Other Mental Health Disorders.

Research has linked pre- and perinatal complications (PPCs) with increased risk for autism spectrum disorder (ASD). However, PPCs are also known risk factors for other mental health disorders. This study explored which PPCs are specific risk factors for ASD, as opposed to other forms of psychopathology, among a large sample of clinically-referred youth. Archival data were used from 1177 youth who were evaluated at a hospital-based autism clinic. Results from logistic regressions indicated that use of tobacco, alcohol, or drugs, or experiencing amniocentesis predicted inclusion in the non-ASD group, while physical difficulties with delivery predicted inclusion in the ASD group. Possible explanations and implications for these findings are discussed.

Investigating the associations between prenatal exposure to substances and intergenerational maltreatment and symptoms of psychopathology for adolescent girls from families with low income.

BACKGROUND: Adolescent girls whose families experience poverty are more vulnerable to psychopathology, and it is vital to investigate biopsychosocial factors contributing to mental health functioning. OBJECTIVE: To test associations between prenatal exposure to substances, intergenerational maltreatment, and adolescent mental health symptoms. PARTICIPANTS AND SETTING: Baseline data were used from a randomized controlled trial testing the efficacy of Interpersonal Psychotherapy (IPT-A) for depression among girls with and without maltreatment exposure. Adolescents (Aged 13-16; 63.5 % Black/African-American, 21.0 % White, 15.57 % other racial identity; 12.57 % Latina/x) were recruited from families experiencing financial adversity (income <200 % poverty threshold). METHODS: Adolescent maltreatment status was determined by using multiple sources (child protective service records, parental report, and adolescent report). Mothers reported on prenatal substance exposure, experiences of maltreatment in their own childhood, and rated adolescent internalizing and externalizing symptoms. Latent Class Analysis was used to determine common patterns of prenatal substance exposure (tobacco, alcohol, marijuana, and cocaine). Structural Equation Modeling was used to evaluate associations between maltreatment in two generations, prenatal exposure to substances, and adolescent mental health symptoms. RESULTS: Two profiles of prenatal substance exposure emerged: one typified by low substance exposure (92.8 %), and one with moderate to high substance exposure (7.2 %). Both prenatal substance exposure and maternal history of maltreatment were associated with adolescent maltreatment, which in turn, was associated with greater adolescent externalizing symptoms. Parental history of maltreatment was directly associated with greater adolescent internalizing symptoms. CONCLUSION: Prenatal exposure to substances and intergenerational maltreatment each confer risk for mental health symptoms in adolescent girls.

Adolescent Depression Symptom Trajectories Detected Via Universal Screening in Pediatric Primary Care.

Unique trajectories of adolescent depression symptoms have been identified, yet less is known about whether such patterns translate to real-world clinical settings. Because annual adolescent depression screening is becoming more prevalent in primary care, we examined whether longitudinal patterns of depression symptoms documented in the developmental psychopathology literature can also be detected via routine screening in primary care and explored how membership in the identified trajectories varied based on concurrent suicide risk and sociodemographic factors. A total of 1,359 adolescents aged 12-16 years old at the first timepoint were included in the current analyses. These adolescents completed three depression screeners during their well-visits in a large pediatric primary care network between November 15, 2017 and February 1, 2020. Retrospective electronic health record data were extracted, including sociodemographic variables and depression screening results. Dynamic functional time series clustering results indicated the optimal number of clusters was five. The five depression symptom trajectories were: (1) A-Shaped (i.e., relatively low depression symptoms at Time 1, a substantial increase in symptoms at Time 2, and a return to low symptoms at Time 3), (2) Increasing, (3) Low-Stable, (4) High-Decreasing, and (5) Low-Decreasing. Cluster differences in suicide risk largely mapped onto depression symptom levels at each assessment. We found cluster differences based on practice location, insurance type, and adolescent race. The symptom trajectories observed in this study resemble those found in the developmental psychopathology literature, though some key differences were noted. Findings can inform future research and symptom monitoring in primary care.

Exploring the role of the self in disgust-related psychopathologies.

While clinical research on disgust relies on nonclinical research, the framework of disgust as an immune mechanism is not as central in clinical research. The immune framework for disgust may be integrated into clinical research by acknowledging the role of the self as the critical element protected by the immune system. In this review, we offer the premise that at the center of all disgust-related behaviors, thoughts, and cognitions is an attempt to protect the self (i.e., "disgust is self-centered" or DISC). We offer evidence in support of DISC and explore the relevance of DISC to clinical research for several disgust-related psychopathologies (obsessive-compulsive disorder, posttraumatic stress disorder, anorexia nervosa, and self-disgust). We then offer future directions for DISC research into disgust-related psychopathologies.

Disgust-induced avoidant processing of autobiographical memories as a transdiagnostic mechanism in the persistence of psychopathology.

We present a model of disgust-induced avoidant processing of autobiographical memories contributing to the persistence of psychopathology. Following the model, autobiographical memory retrieval is biased toward disgust-related experiences. Critically, disgust promotes the avoidance of specific autobiographical memories by reactively aborting the processing of those memories or by strategically preventing access to them, making disgust appraisals immune to corrective information. In the context of eating disorders/body image, studies provided consistent evidence for a bias toward disgust-related memories of their own body in women with a more negative body image. Although the current research casts doubt on disgust-induced strategic avoidant retrieval of body-related memories, it provided initial evidence for reactive avoidance of such memories. Insight into the role of disgust-induced avoidant memory processing as a transdiagnostic mechanism may help in understanding the refractoriness of disgust-relevant psychopathologies (including depressive and trauma-related disorders) and point to the necessity of therapeutic strategies to address disgust-induced avoidance.

Psychopathological profile before and after bariatric surgery.

Presurgical psychopathological assessment usually focuses on detecting severe mental disorders. However, mild intensity psychopathology and eating behaviour pattern may also influence postsurgical outcomes. The aim was to identify psychopathology and eating behaviour pattern in candidates prepared for bariatric surgery compared to a normative population before and after surgery. A cohort of 32 patients seeking bariatric surgery in a university hospital between March 2016 and March 2017 were evaluated with Personality Assessment Inventory (PAI), 36-item EDE-Q and BES before and after surgery. Thirty-two patients before and 26 one year after surgery were included. The PAI presurgical psychometric profile suggested a mild mixed adjustment disorder focused on somatic complaints. After surgery, patients improved in somatic complaints (p < 0.001), and depression (p = 0.04). Related eating disorders were more common than those of the normative group and improved significantly after surgery in scores for compulsive intake (BES p < 0.001) and overall key behaviours of eating disorders and related cognitive symptoms (EDE-Q/G p < 0.001). In our cohort ready for bariatric surgery a mild psychopathological profile is still present and becomes closer to that of the normative group after surgery. Further studies are needed to evaluate the effects of mild psychopathology on outcomes after bariatric surgery.

Interaction between high interleukin-2 and high cortisol levels is associated with psychopathology in patients with chronic schizophrenia.

BACKGROUND: Both cortisol and interleukins appear at abnormal levels in schizophrenia. Our previous study has shown that cortisol and interleukins are associated with psychopathology and response to antipsychotic medications in a relatively small sample size of patients with schizophrenia. The current study was designed to investigate how cortisol, interleukins (ILs) and their interactions would correlate with clinical presentation in a relatively large sample size of patients with schizophrenia. METHODS: We compared serum cortisol, IL-2, IL-6, and IL-8 levels in 162 medicated schizophrenia patients (including 27 patients in remission) and 62 healthy controls. Serum levels of cortisol and interleukins were measured by radioimmunoassay and quantitative ELISA, respectively. Clinical symptoms were assessed according to the Positive and Negative Syndrome Scale (PANSS). RESULTS: Patients with schizophrenia had significantly higher levels of cortisol and IL-2 compared to controls. Patients in remission had higher levels of IL-6 than non-remitting patients. PANSS positive symptoms, general psychopathology, cortisol and IL-2 were the most central nodes in the cortisol-IL-symptom network. The interaction between cortisol and IL-2 was associated with PANSS positive symptoms, general psychopathology and depressive factor. For patients with cortisol level above the median, IL-2 was negatively associated with PANSS positive symptoms and general psychopathology. CONCLUSIONS: Our results indicated that the interaction between cytokines and cortisol may be associated with the pathophysiology of some symptoms in chronic schizophrenia. In particular, the interaction between cortisol and IL-2 is associated with the clinical phenotypes of schizophrenia.

Helpful activities during the COVID-19 pandemic: Perceived benefits and actual association with psychiatric symptoms and psychological wellbeing.

BACKGROUND: Few studies have rigorously examined the effectiveness of commonly reported coping activities during the COVID-19 pandemic. This study was designed to assess perceived helpful activities during the pandemic and to investigate the extent to which these activities were associated with psychological outcomes. METHOD: Adults living in the US (N = 204), who were part of a longitudinal family study of depression responded to an online survey. They reported on their perceived helpful activities during the pandemic. General linear regression models (GLM) were used to evaluate the association between perceived helpful activities and current psychiatric symptoms, controlling for demographic factors, and pre-pandemic psychiatric history and symptoms. RESULTS: The top perceived helpful activity during COVID-19 was communicating with friends/family via telephone text or video (75.5 %). However, of the top five activities endorsed, cooking/baking was associated with the most clinical outcomes, including lower anxiety/depression and greater psychological wellbeing (all ps < 0.05). These relationships were most prominent among younger individuals < age 40 years, females, and those with recent psychiatric history, although they extended to younger males, and individuals at high or low depression risk. LIMITATIONS: Close ended items limited variability in coping activities reported. The study lacked data on substance use. The sample was racially and ethnically homogenous. CONCLUSIONS: These findings move beyond anecdotal evidence that cooking/baking as a coping activity yields protection against psychopathology. Its ready accessibility and ability to confer benefits across a range of individual characteristics, make it a useful adjunct in therapeutic interventions for people confined to their homes.

Psychological/Personal recovery and its correlates in patients with first episode psychosis.

BACKGROUND: Recovery in psychosis is a multidimensional construct. The numbers of studies specially focusing on the recovery aspects in patients with first episode psychosis (FEP) are limited, with no study from India. Further, no study has looked specifically into the variables that affect recovery process in patients with FEP and little is known about factors which influence recovery in patients with FEP. AIM: To evaluate psychological recovery and its correlates in patients with FEP, currently in clinical remission. METHODOLOGY: One hundred three patients of FEP in clinical remission were assessed on Recovery Assessment Scale (RAS), Positive and Negative Syndrome Scale for Schizophrenia, Calgary Depression Rating Scale for Schizophrenia, Negative Symptom Assessment 16, Rosenberg Self-esteem Scale, Social and Occupational Functioning Assessment Scale, the Alcohol, Smoking and Substance Involvement Screening Test, Beck Cognitive Insight Scale, Internalized Stigma of Mental Illness Scale, the Everyday discrimination Scale, Subjective Scale to Investigate Cognition in Schizophrenia and social cognitive deficits in theory of mind was evaluated on the Social Cognition Rating Tools in Indian Setting-Theory of Mind. The needs of the participants were assessed on the Camberwell Assessment of Needs - Research version and Supplemental Assessment of Needs. Coping, social support, medication adherence were also assessed by standardized scales. RESULTS: The mean weighted score was highest for goal and success orientation subscale followed by seeking and relying on social support, personal confidence and hope, overcome the illness and awareness and control over the illness as assessed by 41 items of the RAS. The main factors identified to affect psychological recovery in patients with FEP were duration of untreated psychosis, greater psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigmatization. CONCLUSION: The present study suggests that treatment of FEP should be started at the earliest and issues such as residual psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigma during the remission phase should be addressed by psychosocial interventions to promote psychological recovery in patients with first episode psychosis.

Intensity of mental health treatment of cancer-related psychopathology: the predictive role of Early Maladaptive Schemas.

PURPOSE: With the limited availability of mental healthcare, it is of utmost importance to provide care that matches the needs of patients: short if possible, but also more intense when necessary. This study explored whether Early Maladaptive Schemas (EMSs) play a predictive role in the intensity of needed mental health treatment of cancer-related psychopathology. METHODS: EMSs were assessed before mental health treatment in 256 patients who sought help at a specialized mental health care centre for those affected by cancer in the Netherlands. Data about treatment indication and intensity of mental health treatment were collected. Univariate and multivariate logistic regression analysis were used to assess the predictive value of the EMSs total score and specific domains on treatment indication and treatment intensity. RESULTS: The presence of more severe EMSs predicted an indication for a more intense mental health treatment before start of the treatment, and actual more intense mental health treatment. The domain Impaired Autonomy and Performance appeared to be conceptually close to the domain Disconnection and Rejection, we left the latter out in our multivariate analysis and then found that Impaired Autonomy was the best predictor of intensity of mental health treatment. CONCLUSION: Our findings imply that assessing EMSs could help to identify patients who will receive more treatment time.

Trajectories of Psychopathology and Dysregulation 2-4 Years following Adolescent Bariatric Surgery.

OBJECTIVE: This study examined psychopathology and weight over 4 years following bariatric surgery in adolescents with obesity, as compared to a nonsurgical group. The role of psychological dysregulation in relation to psychopathology in the 2-4 year "maintenance phase" following surgery was also examined. METHODS: Adolescent participants (122 surgical and 70 nonsurgical) completed height/weight and psychopathology assessments annually for 4 years, with dysregulation assessed at Year 2. Analyses examined the association of "High" and "Low" psychopathology with weight over time using logistic regression. Mediation analyses in the surgical group examined indirect effects of dysregulation on percent weight loss through Year 4 psychopathology. RESULTS: There were lower odds of "High" internalizing symptoms in the surgical group versus the nonsurgical group from baseline (presurgery) to Year 4 (OR = .39; p < .001; 42.3% "High" internalizing in surgical; 66.7% in nonsurgical) and during the 2-4 year maintenance phase (OR = .35, p < .05; 35.1% "High" internalizing in surgical; 60.8% in nonsurgical). There was a significant mediation effect in the surgical group: higher dysregulation was associated with greater Year 4 internalizing symptoms (ß = .41, p < .001) which in turn was associated with less Year 4 percent weight loss (ß = -.27, p < .05). CONCLUSIONS: While the surgical group was less likely to experience internalizing symptoms, internalizing psychopathology was related to less percent weight loss in this group. Internalizing symptoms mediated the relationship between dysregulation and percent weight loss in the surgical group. Postoperative mental health follow-up is needed for adolescents into young adulthood.

Crisis y encrucijadas de una psiquiatría en busca de futuro / The crisis and crossroads experienced by a psychiatry in search of the future

Asumiendo la metáfora de la encrucijada, propuesta por Santiago Levín, en la que estaría situada la psiquiatría en la actualidad, el presente artículo pretende reflexionar sobre algunos aspectos de una crisis paradigmática de la medicina mental que ha hecho a algunos temer por su futuro. Se abordan algunas cuestiones epistemológicas de cierto calado, como el régimen de "verdad" en el que supuestamente deben manejarse los expertos, así como los dilemas planteados en los dos elementos clave del encuentro clínico: el diagnóstico y el tratamiento. Finalmente, se insiste en la importancia de lo ético, lo social, y lo político a la hora de replantear saberes y prácticas. (AU)

On the understanding we accept where psychiatry would today be located in the metaphor of the crossroads, as proposed by Santiago Levín, the purpose of this article is to explore certain aspects of a paradigmatic crisis in mental medicine that has raised some concerns as to its future. Certain deep epistemological questions are addressed, such as the schema of "truth", where experts should supposedly manage themselves, and the dilemmas raised from the two key elements of a clinical session: diagnosis and treatment. Finally, the study emphasises the importance of the ethical, social, and political aspects of rethinking knowledge and practices. (AU)

Weighing psychosocial factors in relatives for the risk of psychopathology: a study of patients with depressive and anxiety disorders and their siblings.

PURPOSE: Siblings of probands with depressive and anxiety disorders are at increased risk for psychopathology, but little is known about how risk factors operate within families to increase psychopathology for siblings. We examined the additional impact of psychosocial risk factors in probands-on top of or in combination with those in siblings-on depressive/anxious psychopathology in siblings. METHODS: The sample included 636 participants (Mage = 49.7; 62.4% female) from 256 families, each including a proband with lifetime depressive and/or anxiety disorders and their sibling(s) (N = 380 proband-sibling pairs). Sixteen psychosocial risk factors were tested. In siblings, depressive and anxiety disorders were determined with standardized psychiatric interviews; symptom severity was measured using self-report questionnaires. Analyses were performed with mixed-effects models accounting for familial structure. RESULTS: In siblings, various psychosocial risk factors (female gender, low income, childhood trauma, poor parental bonding, being single, smoking, hazardous alcohol use) were associated with higher symptomatology and likelihood of disorder. The presence of the same risk factor in probands was independently associated (low income, being single) with higher symptomatology in siblings or moderated (low education, childhood trauma, hazardous alcohol use)-by reducing its strength-the association between the risk factor and symptomatology in siblings. There was no additional impact of risk factors in probands on likelihood of disorder in siblings. CONCLUSION: Our findings demonstrate the importance of weighing psychosocial risk factors within a family context, as it may provide relevant information on the risk of affective psychopathology for individuals.

Parental drug use disorders and youth psychopathology: Meta-analytic review.

Parental drug use disorders (PDUDs) represent a highly prevalent risk factor for youth's development of psychological and substance misuse. However, most research on associations between parental substance use and child mental health focuses on composites of parental drug, alcohol, and tobacco use. PDUDs are associated with a range of legal, health, and environmental risks that make them substantially distinct from tobacco and alcohol misuse, yet associations between PDUDs and youth psychopathology symptoms have yet to be assessed quantitatively using meta-analytic techniques. Accordingly, the present meta-analysis assessed the association between PDUDs and youth's internalizing, externalizing, substance use, and total psychological problems across 30 studies (N = 8433). Meta-analytic findings showed that PDUDs were associated with greater substance use and total psychological problems in youth. Across studies, PDUDs were not associated with broad dimensions of youth internalizing and externalizing symptoms but demonstrated a positive relation with youth ADHD and conduct disorder symptoms. There were significant moderation effects for study quality, symptom informant, and child age, where the association between PDUDs and child symptoms of psychopathology was stronger for older youth, in higher quality studies, and studies using joint parent-child symptom informants. Taken together, the meta-analytic findings suggest that PDUDs present a significant risk factor for youth. Future research targeting the relation between parental drug use and youth psychopathology is warranted for prevention and intervention efforts. Implication of findings, mechanisms of interest, and an agenda for future research are discussed.

Youth Mental Health Screening and Linkage to Care.

One Mind, in partnership with Meadows Mental Health Policy Institute, convened several virtual meetings of mental health researchers, clinicians, and other stakeholders in 2020 to identify first steps toward creating an initiative for early screening and linkage to care for youths (individuals in early adolescence through early adulthood, ages 10-24 years) with mental health difficulties, including serious mental illness, in the United States. This article synthesizes and builds on discussions from those meetings by outlining and recommending potential steps and considerations for the development and integration of a novel measurement-based screening process in youth-facing school and medical settings to increase early identification of mental health needs and linkage to evidence-based care. Meeting attendees agreed on an initiative incorporating a staged assessment process that includes a first-stage brief screener for several domains of psychopathology. Individuals who meet threshold criteria on the first-stage screener would then complete an interview, a second-stage in-depth screening, or both. Screening must be followed by recommendations and linkage to an appropriate level of evidence-based care based on acuity of symptoms endorsed during the staged assessment. Meeting attendees proposed steps and discussed additional considerations for creating the first nationwide initiative for screening and linkage to care, an initiative that could transform access of youths to mental health screening and care.

Multiple lifestyle risk behaviours and hierarchical dimensions of psychopathology in 6640 Australian adolescents.

OBJECTIVE: Physical inactivity, sugar sweetened beverage consumption, alcohol use, smoking, poor sleep and excessive recreational screen time (the 'Big 6' lifestyle risk behaviours) often co-occur and are key risk factors for psychopathology. However, the best fitting latent structure of the Big 6 is unknown and links between multiple lifestyle risk behaviours and hierarchical dimensions of psychopathology have not been explored among adolescents. This study aimed to address these gaps in the literature. METHODS: Confirmatory factor analysis, latent class analysis and factor mixture models were conducted among 6640 students (Mage = 12.7 years) to identify the latent structure of the Big 6 lifestyle risk behaviours. Structural equation models were then used to examine associations with psychopathology. RESULTS: A mixture model with three classes, capturing mean differences in a single latent factor indexing overall risk behaviours, emerged as the best fitting model. This included relatively low-risk (Class 1: 30%), moderate-risk (Class 2: 67%) and high-risk (Class 3: 3%) classes. Students high on externalizing demonstrated significantly greater odds of membership to the high-risk class (odds ratio = 8.75, 99% confidence interval = [3.30, 23.26]) and moderate-risk class (odds ratio = 2.93, 99% confidence interval = [1.43, 5.97]) in comparison to the low-risk class. Similarly, students high on internalizing demonstrated significantly higher odds of membership to the high-risk class (odds ratio = 1.89, 99% confidence interval = [1.06, 3.37]) and the moderate-risk class (odds ratio = 1.66, 99% confidence interval = [1.03, 2.67]) in comparison to the low-risk class. Associations between lower order factors of psychopathology and lifestyle risk behaviours were mostly accounted for by the more parsimonious higher order factors. CONCLUSION: Classes representing differences in probabilities of the Big 6 lifestyle risk behaviours relate to varying levels of hierarchical dimensions of psychopathology, suggesting multiple health behaviour change and transdiagnostic intervention approaches may be valuable for reducing risk of psychopathology.

Evaluation of delay discounting as a transdiagnostic research domain criteria indicator in 1388 general community adults.

BACKGROUND: The Research Domain Criteria (RDoC) approach proposes a novel psychiatric nosology using transdiagnostic dimensional mechanistic constructs. One candidate RDoC indicator is delay discounting (DD), a behavioral economic measure of impulsivity, based predominantly on studies examining DD and individual conditions. The current study sought to evaluate the transdiagnostic significance of DD in relation to several psychiatric conditions concurrently. METHODS: Participants were 1388 community adults (18-65) who completed an in-person assessment, including measures of DD, substance use, depression, anxiety, posttraumatic stress disorder, and attention-deficit hyperactivity disorder (ADHD). Relations between DD and psychopathology were examined with three strategies: first, examining differences by individual condition using clinical cut-offs; second, examining DD in relation to latent psychopathology variables via principal components analysis (PCA); and third, examining DD and all psychopathology simultaneously via structural equation modeling (SEM). RESULTS: Individual analyses revealed elevations in DD were present in participants screening positive for multiple substance use disorders (tobacco, cannabis, and drug use disorder), ADHD, major depressive disorder (MDD), and an anxiety disorder (ps < 0.05-0.001). The PCA produced two latent components (substance involvement v. the other mental health indicators) and DD was significantly associated with both (ps < 0.001). In the SEM, unique significant positive associations were observed between the DD latent variable and tobacco, cannabis, and MDD (ps < 0.05-0.001). CONCLUSIONS: These results provide some support for DD as a transdiagnostic indicator, but also suggest that studies of individual syndromes may include confounding via comorbidities. Further systematic investigation of DD as an RDoC indicator is warranted.

Prevenção do suicídio: esquecimento do ser e era da técnica / Suicide prevention: forgetfulness of being and technical era / Prevención del suicidio: olvido del ser y la era de la técnica

Martin Heidegger, em sua ontologia, destaca uma característica específica da atualidade que atravessa o comportamento humano, na filosofia, na ciência ou no senso comum: o esquecimento do ser. O filósofo diferencia a época atual das demais épocas históricas. O horizonte histórico contemporâneo se desvela por meio do desafio e da exploração, da tentativa de controle e domínio dos acontecimentos, ao modo da disponibilidade e em função da produtividade. O filósofo esclarece que todo esse desenraizamento do homem atual está atrelado ao esquecimento daquilo que é o mais essencial, qual seja, a existência. A questão que norteia este estudo é apurar, por meio das referências de Heidegger e dos estudos sobre suicídio, o quanto a interpretação da morte voluntária nos dias atuais está atravessada por tal esquecimento. Pretendemos investigar o quanto as ações de prevenção desenvolvidas pela suicidologia se encontram atravessadas por tal esquecimento do ser do homem e, dessa forma, acabam por estabelecer relações entre ser e ente em uma consequente redução ao ente como invariante e atemporal. O caminho para investigar a questão iniciará por abordar, em maiores detalhes, a analítica existencial, a questão da técnica e o movimento de esquecimento do ser apontados por Heidegger a fim de problematizar as perspectivas científicas atuais sobre o suicídio em sua prevenção para, então, estabelecer uma compreensão fenomenológica e existencial sobre o referido fenômeno.(AU)

Martin Heidegger, in his ontology, highlights a specific characteristic of the present moment that crosses human behavior, in philosophy, science, or common sense: the forgetfulness of being. The philosopher differentiates the current age from other historical ages. The contemporary historical horizon is unveiled by the challenge and the exploration, from the attempt to control and dominate events, to the mode of standing reserve and in terms of productivity. The philosopher clarifies that all this uprooting of the current man is linked to the forgetfulness of what is the most essential, namely, the existence itself. The question that guides this study is to investigate, via Heidegger's references and studies on suicide, to what extent the interpretation of voluntary death today is crossed by such forgetfulness. We intend to investigate to what extent the prevention actions developed by suicidology are crossed by such forgetfulness of the human's being and, in this way, they end up establishing relationships between being and entity in a consequent reduction to entity as an invariant and timeless. The path to investigate the issue will start by addressing, in greater detail, the existential analytics, the question concerning technique and the movement of forgetting the being pointed out by Heidegger to problematize the current scientific perspectives on suicide and its prevention to, then, propose a phenomenological and existential understanding about the referred phenomenon.(AU)

Martin Heidegger en su ontología destaca una característica específica del presente que atraviesa el comportamiento humano, ya sea en la filosofía, la ciencia o el sentido común: el olvido del ser. El filósofo diferencia la época actual de otras épocas históricas. El horizonte histórico contemporáneo se devela el desafío y la exploración, el intento de controlar y dominar los eventos, en la modalidad de disponibilidad y en términos de productividad. Y así aclara que todo este desarraigo del hombre actual está involucrado en el olvido de lo más esencial, que es la existencia misma. A partir de las referencias a Heidegger y de los estudios sobre el suicidio, este estudio busca saber hasta qué punto la interpretación de la muerte voluntaria hoy está atravesada por este olvido. Pretendemos investigar en qué medida las acciones de prevención desarrolladas por la suicidología se encuentran atravesadas por el olvido del ser del hombre y, de esta manera, terminan por establecer relaciones entre el ser y el ente, en una consecuente reducción al ente como invariante y atemporal. Para investigar el tema se abordará inicialmente, con mayor detalle, la analítica existencial, la cuestión de la técnica y el movimiento del olvido del ser señalado por Heidegger para problematizar las perspectivas científicas actuales sobre el suicidio y su prevención y, luego, proponer una comprensión fenomenológica y existencial sobre el referido fenómeno.(AU)